Q. I am 29 years old and engaged to be married. I am very excited, but as we make plans for our honeymoon, I am starting to get worried as well. And I’m too embarrassed about this problem to know where to turn for help.
I am in good health, but sometimes when I cough or sneeze, I can’t hold my urine in. This is bad enough, but every so often at night I dream that I am looking for a restroom, and when I wake up the bed is wet.
I would be mortified if this happened on my honeymoon. Isn’t there some medicine children take to keep them from wetting the bed? Would it work for me too?
A. You need to make an appointment with a urologist for proper diagnosis. Urinary incontinence is not uncommon, but of course you do not want to wet the bed.
Bladder training and learning special exercises to strengthen the pelvic muscles (Kegels) can be very helpful for “stress incontinence.” (This is urinary leakage during a laugh, cough or sneeze, or during exercise such as lifting, running or jumping.) Biofeedback can sometimes help with this training. Be patient; it may take several weeks to notice the improvement.
Some doctors may also prescribe estrogen or oral decongestants to tighten the sphincter. Vaginal estrogens are used primarily in women older than you who have already gone through menopause.
To keep from wetting the bed at night, avoid caffeine during the day and reduce fluid intake a few hours before bedtime. Some people find that avoiding alcohol is also useful. If this doesn’t help, the urologist may consider prescribing DDAVP (desmopressin), a nasal spray more often used for children. This medication dramatically reduces urine formation and the chance of an “accident.”
Kegel exercises and reducing caffeine and evening fluid intake will probably do the job. If these practices or medications are not enough to control urinary leakage, some urologists will inject collagen or even Botox (Drugs, July 2013) to help with bladder control. Surgery may be a last resort, but in appropriate cases it can work very well.